Patellofemoral complications continue to form a large proportion (up to 50%) of total knee arthroplasty (TKA) complications. If adequate attention is paid intraoperatively to patellar tracking and component position, the incidence of subluxation, component loosening, and fracture should decrease. When treating patellar subluxation and dislocation, tibial tubercle transfer should be avoided because there is an unacceptably high incidence of complications. Care should be taken to treat the underlying cause of dislocation with either a soft tissue procedure or component revision. Fracture of the patella may be treated nonoperatively in 50% and 80% of patients. Cysts, if large, may be bone-grafted to avoid the potential complications of stress fracture and component loosening. Loosening of the patellar component is likely to be symptomatic and to require surgery in up to 75% of cases. A displaced patellar component may cause attritional wear of the quadriceps tendon or patellar ligament. All rheumatoid patellae should be resurfaced. The present trend in the osteoarthritic patella is toward resurfacing more often. With improved implant design and a predicted decrease in complications, resurfacing in the osteoarthritic patella may become routine. Osteoarthritic patellae that maintain good cartilage, normal anatomic shape, and congruent tracking need not be resurfaced.